A Parent's Chastening Shake, Warns Dr. Stephen Ludwig, Can Be a Deadly Form of Child Abuse

The baby is crying incessantly. Its mother feeds it, changes it, coos to it. Nothing works. Finally, in a moment of innocent frustration, the mother picks up the infant and shakes it, gently but firmly. The baby's head wobbles back and forth.

Medical science has no way of knowing how many times that scene is repeated every day. But now doctors have discovered that such apparently harmless incidents, which few would call child abuse, may inflict lasting damage to babies' brains. What happens, according to Dr. Stephen Ludwig, a pediatrician who heads the emergency department at Children's Hospital in Philadelphia, is that as the baby's head bobs back and forth, its brain bangs against its skull, causing ruptures of numerous blood vessels. (An infant's brain, for about the first year, has only a thin layer of insulating myelin, a fatty substance that cushions older children's brains against such shocks.) Among the lifelong effects that may follow such damage, says Ludwig, are loss of vision, loss of control over a limb, epilepsy and mental retardation. Ludwig calls it the "Shaken Baby Syndrome," and warns that another, even more common parental act—tossing babies into the air and catching them on the way down—may have a similar effect.

Ludwig, 36, a Penn State alumnus with an M.D. from Temple University, joined the Children's Hospital staff in 1974. A 1971 British medical journal article by Dr. Norman Guthkelch first cited the dangers of shaking babies and alerted Ludwig to the problems. Now a leading researcher in the field, Ludwig estimates he has treated some 20 infants with symptoms of Shaken Baby Syndrome; three of the children ultimately died. Some, perhaps the majority, of those cases were victims of malicious abuse. "Most of the people we see want and love their kids," Ludwig observes. "They just go off the track somewhere and injure them."

Determining how many babies are injured by shaking or good-natured roughhousing is still difficult. Dr. Harold Rekate of Cleveland's Case-Western Reserve University Medical School estimates that his hospital treats some 20 shaken baby cases a year. "One of the telltale signs that a child has been severely shaken," he notes, "is that there are hemorrhages in the retina of the eye." Ludwig worries that the majority of injuries go undetected. "There are a large number of cases where the behavior is going on," he notes, "but where there is not sufficient noticeable injury, it just continues."

Ludwig knows about the travails of parenthood. His first child was born with an incomplete esophagus. The premature baby spent the first four months of her life in the neonatal wing of Children's Hospital National Medical Center in Washington, D.C., where Ludwig was serving his residency. A part of her stomach was used to replace the missing piece of esophagus, however, and Susannah Ludwig is now a healthy 11-year-old; she has two sisters. "That experience really taught me a great deal about being the parent of a hospitalized child," Ludwig recalls.

When he first observed battered children as an intern, he assumed that child beaters were truly evil people. He has since changed his mind. "Anyone," he says, "could be an abusive person, if he is put under the right set of circumstances. I don't single out a group of people as child abusers. I think now that they are us, we are them." Ludwig and Zella, his wife of 14 years, a former restaurateur, have spanked their daughters only rarely.

At Children's, where his emergency staff includes five full-time pediatricians and 10 residents, Ludwig has earned a reputation for working sensitively with the parents of children who have been abused, accidentally or otherwise. Says Tony Mauro, director of social work at the hospital: "Steve has been able to make the human connection. When he says to a parent, 'We are going to get help for you, we know you don't want to hurt your child,' they believe him."